B LE BARON BAYLIES, M., TEMPORARY CHAIRMAN.
MANAGEMENT OF DISPLACEMENTS WITHOUT MECHANICAL SUPPORT.
J.T. KENT, M.D.
If it should be stated in other than the Hahnemannian Association that the displacements of the uterus could be cured, or palliated even, without mechanical support, the advocate would find few believers, either in his statement or in his plan of action. But it is expected that the law of cure is universal; therefore it is almost needless to assert that our materia medica is ripe enough (which we all know) to manage these conditions without mechanical support.
Any physician in active practice among women must find a large percentage of his cases belonging to this category. the various classifications resorted to in text books for pathological study have very little value in the matter of cure; the wilderness of symptomatology furnishes us the only hope of taking these cases to a successful termination, which is permanent and radical cure.
The Hahnemannian finds no place in his practice for mechanical support; he relies always upon the indicated remedy. There can be no proof like actual cures. this method is successful or it is attended with failure; living witnesses must testify to its usefulness. The report of a few cases would seem quite useful as an explanation of what must be done and how the work must be carried out to avoid the use of mechanical support in displacements.
Whenever a patient presents herself to a Hahnemannian physician for relief for the complexity of symptoms belonging to displacements, not only the symptoms of the displacement but all the symptoms of the case, from childhood to the present time, must be as accurately written down as it is possible to obtain them, after the method directed by the Organon. the fullest detail of general symptoms must be taken, as it is quite probable that the symptom image will be made up or strengthened by what would be considered as concomitant symptoms.
An examination such as is generally given is of the smallest importance in the case, and reveals nine of the peculiar characteristics upon which the physician must rely for this symptoms image. Many of these cases appear wearing the mechanical support of the last physician in attendance.
Under such circumstances, the symptoms of most value do not appear. With the support, she is relieved and permitted to walk, stand and perform her family duties with out much suffering. the mechanical support must be removed at once by the physician or the patient, if she be so instructed. She must be immediately placed upon Sac, Lac., and at least a week permitted to pass before a full symptom image will be found; it sometimes requires a month before the symptoms appear that were present before she was tampered with by mechanical support.
The patient will usually remark to the physicians, RI can not walk if my supporter be removed.” Now this is what becomes necessary, and is usually what I want to hear her say. I immediately ask the question, “why can you not walk, if this supporter be removed?
The answer brings the symptoms, that I write down, and with the others the image becomes complete after she has rested a sufficient time to permit the symptoms, that have been removed by the pessary to return, so that finally the fullest expression of the symptom image is made out.
Sometimes she may be able to relate with great fullness all the symptoms that were there before the pessary was used, and even the symptoms that will come back after the removal of the support, because she has become so familiar with them that she can relate them in full. Others have given little attention to the real symptoms of the case, having worn their pessary so long, and been subjected to such extensive local treatment.
It matters not how soon the symptoms are gathered, only so they are gathered in completeness as the honest expressions of nature, and not the misrepresentations, such as must come in many cases where the mechanical support has completely changed the surrounding parts. If these details are not carried out in fullness, no physician need undertake to make a homoeopathic prescription.
The symptoms that have been removed-no matter how removed-are the outward expressions of the inner nature of the disease to be cured. If they are not present, they must be permitted to return in order to appeal to the intelligent physician, as all diseases do, by signs and symptoms, and so long as they do not appeal to him by signs and symptoms they are incurable. When all support has been sufficiently removed, the rule is that these diseases do appeal to the intelligent physician by natural signs and symptoms.
It has been said that mechanical support is necessary in aged women. This is seldom true, if ever, as the indicated remedy will remove the displacements in feeble and broken-down ladies. For an example, let us look at the following case:.
A lady sixty-five years of age consulted me for procidentia. She was compelled to wear a T bandage whenever she walked; lying down gave her some relief; bloody, watery leucorrhoea which was offensive. She was greatly emaciated, waxy, bloodless, scrawny. Skin very dry and shrivelled. Toes becoming dark with gangrenous patches. Occasional attacks of bloody diarrhea. Great weakness. Believed herself near the end. Had suffered from this extensive displacement for more than twenty years.
Had on numerous occasions attempted to wear mechanical support, always failing because of the soreness of the parts. Scale cured in a very short time, and the women has gained flesh, strength and color, and is in excellent spirits. In such instances, if cure can be performed where mechanical support can not be tolerated, why not in cases most suitable to mechanical contrivances? This remedy would be seldom thought of by routinists for displacement, but it corresponded to the peculiarities of the patient.
Another case wherein a remedy was administered that would seldom be thought of, it aimed at prolapsus, was as follows:.
A tall woman suffered many years from extreme prolapsus. Great hearing down in the pelvis. When at stool, numerous hemorrhoidal tumors protruded, which seemed full of sticking pains; much burning, and often attended with haemorrhage. Extreme pain, aching, bruised, through sacrum and hips when walking; pain extending down the thigh. the only comfortable position was lying in bed. Aesculus this patient promptly. when she appeared for treatment she wore a horseshoe pessary, which was removed in the usual manner by the patient, and the symptoms of the prolapsus permitted to appear.
Another important application of a remedy: A middle-aged lady, mother of several grown daughters, appeared with what seemed to be a most important, peculiar mental symptom, which was explained by her husband. She only desired to be relieved of her mental anxiety at first, saying nothing about any displacement from which she had long suffered. The anxiety was of the nature of fear in the absence of her husband, fear that he would never return to her, fear that he would die, fear that he would be run over by the cars.
It had grown so much upon her that she would weep during his entire absence; even attended him at his place of business to be with him. She had no desire to mention the fact that she was then suffering from a displacement, and was then wearing a pessary, not thinking that her displacement, and was them wearing a pessary, not thinking that her displacement had any relation to her mental anxiety. But in the search for symptoms, it was ascertained that she had been treated extensively for a displacement, and was then wearing a pessary.
She knew so little about Homoeopathy that she supposed it possible to continue with her specialist for the displacement, and had simply consulted me because she had heard of some success in the management of mental cases. The removal of the pessary was insisted upon, which was carried out. She then informed me why it had been necessary, and the nature of the displacement, which had been carefully diagnosed by her attending physician.
The other symptoms of the case, as they developed, were copious menstrual flow, which was black and clotted; extreme sensitiveness of the genital organs, which prevented wearing the usual napkin during her monthly indisposition. These completed the symptom image which was so like Platina, that a beginner should not make a mistake. This remedy was quite sufficient to remove not only the mental symptoms, but the necessity for the continuation of any mechanical support.
It is not necessary to continue the further report of cases. Remedies having a reputation, when indicated, for curing such conditions are Bell, Lil, Murex, Nux V, Pod, Puls, Sepia. The indications for these medicines should certainly be very simple; they are in all the text books; they are open to the study of any physician who desire to follow the law. It is no secret method that the Hahnemannian physician employs in the management of these cases. “He who runs may read”.
If the patient presents the vascular fullness, the bearing-down pains in the pelvis, as if the uterus would escape through the vagina; the extreme sensitiveness to the jar of a wagon or a street car; the marked heat of the menstrual flow, which is generally copious, clotted, black, mixed with bright red blood; the instinctive demand to press the external genitalia with the hand or with a napkin to prevent the protrusion of inner parts. With such symptoms, who could help thinking of Belladonna?.
With the same dragging down and the same desire for external pressure over the parts, we should add the awful sense of hunger in the stomach, even after eating, which has an emptiness, a goneness, a sinking; lingering constipation with a sexual instinct that drives her frantic. Who could help but think of Murex?.
Then slightly deflect the picture-with an overpowering sleepiness, so that during the entire day she can scarcely keep awake-who would not think of Nux moschata?.
Then consider the extreme snappishness f temper with intestinal pains, with much pain and urging to stool, which is not successful; continued urging to urinate; who would not think of Nux vomica?.
With all these bearing-down pains at every stool; with prolapsus of the rectum: alternation of diarrhea and constipation; after the diarrhea, which completely empties out the colon with gushing stool, the awful emptiness of the abdominal cavity which amounts to a deathly goneness, as if she must sink; – who could help but think of Podophyllum?.
It may next be asked how rapidly are these cases cured. To a great extent this depends upon how much the symptoms have been disturbed by previous inappropriate treatment, and how much the constitution of the patient has been broken down by overwork, and the tenacity of the primitive miasm against which remedies must be directed. For instance, when Belladonna has been the medicine that has given the immediate relief, it will naturally be followed by its chronic.
No case should be abandoned after the more removal of the symptoms of displacement. Deep acting medicines become indicated as the final remedies in the case when the first remedy has only laid the foundation for cure. In any experience two remedies have usually been sufficient to cure, and the time required has been from six months to a year. In extremely broken-down constitutions the time is much extended.
The percentage of failures should be very small. Indeed, no more manageable class of conditions come under the observation of a careful prescriber. No more could I say to emphasize this than that thus far I have met with no failures; all that have appeared have no more desired, nor felt the necessity for, mechanical support.
Dr. Campbell; In this class of cases Lilium has served me wonderfully. It has done more for me than is usually expected of one remedy.
Dr. Bell: One of the most important lessons we learn from the allopathic system of medicine is, how not to do it. There is no particular objection from a homoeopathic stand point to mechanical supports for the uterus, any more than there is to a truss for hernia; but, as a matter of fact, there are great many mechanical objections, to these uterus, used to b a great fellow in the allopathic school, but we seldom hear about him now.
Only ten years ago there was hardly to be found a correct representation of the pelvic organs in the text books. The uterus was shown upright, the rectum and vagina uncollapsible tubes, and the bladder anywhere it could be crowded in. With such radically wrong notions every woman had a displacement and pessaries could be used wholesale. By means of frozen sections the normal position of the female pelvic organs was discovered to be very different from the old idea.
The allopathic authorities found that the uterus was a movable organ, with no fixed position in which it could or should be held by a mechanical support. The day of the pessary in the old school has practically gone by, with the exception, perhaps, of the stem pessary, of which they are very much afraid. They have also found that mere changes of position in the uterus, backward or forward, have but little bearing on the health.
Aggravated cases of displacement very often present few symptoms of ill health, while on the other hand, severe suffering and many symptoms are often present when the degree of displacement is but slight. There is only one condition that seems to require surgical interference, and that is procidentia with a torn entrance to the pelvis, and great relaxation of the parts.
Such cases often show but very few symptoms upon which to base a prescription, and to such, surgical measures are certainly appropriate. Very little room any where has been left for mechanical supports.
Dr. Hawley: Women are no more likely to be sick because they are women, then men are because they are men. Women are curable by exactly the same method as men. I pay no more attention to the mechanical symptoms than to any others. As a rule, the mechanical symptoms are all hearsay.
The woman only knows her womb is out of place because some doctor has told her so, and she refers all her troubles to this terrible misplacement, the thought of which the doctor has put into her head. You must go to work and get the case just as you would any ordinary sickness and administer your remedy without any special reference to the mechanical symptoms.
A young lady of sixteen had a truck played upon her by her little brother; he pulled away a chair just as she was about to sit down upon it. She seemed shocked but soon recovered, and went to school as usual next morning. Soon her health began to fail and a physician was called in. He heard her history, made an examination and pronounced her case one of retroversion of the uterus. In spite of the services of seven of the most prominent allopathic physicians of Chicago, she remained an invalid for seven years, for three of which she did not stir out of the house.
They all agreed on the diagnosis. She was also under Dr. J. Weir Mitchell, of Philadelphia. The history of treatment of this case is simply astonishing, to show how little help there is in the best old school skill. She finally came into my hands. I made no manual examination of the case. I did not even feel her pulse, but I cured her. When her menses came on I never saw in my life such suffering. That was in November. The next August that girl up at three in the morning during menstruation and went home, a long journey, without any discomfort whatever.
Dr. Stow: As a rule, I have not found it necessary to use mechanical supports in such cases, but I have found them occasionally useful. A lady called on m for treatment near the menopause. I prescribed for her for three weeks without a digital examination. I had to make one finally and and found very pronounced retroflexion with absorption of the posterior tissue of the cervix. Sepia covered nearly all of her symptoms.
She had a “dragging down” in the rectum; drawing outside of the thighs, crossed her limbs when she stood or sat down, pain in her back, etc. I administered Sepia and applied a rubber stem repositor in the mouth and neck of the uterus, having first pushed the organ into weeks. During that time it became necessary to withdraw the stem repositor about every fourth day. At the expiration of two weeks I found the patient much better, and in six weeks quite well. She has since borne a beautiful girl. I do not know whether she would have got well with Sepia alone or not; I am inclined to think not.
Dr. Reed: It seems to me that the last speaker deprived himself of the possibility of obtaining useful information by the use of mechanical appliance. We have the pathogenesis of Sepia, and when the symptoms of the patient correspond to that pathogenesis we must use Sepia, and depend upon it; so of Lilium or any other drug. I come from away back; yes, from a country of Egyptian darkness, and when am obliged to listen to such cases as this, it reminds me of the time when I was an allopath. I have gynecological chair in my office and I have not used it three times in six years, and yet I make a living. I give my patient a dose of medicine, and if it is the similimum of the case, I know that it will cure the case.
A lady came to me, not very long ago, in a desperate condition. She had a terrible bearing down sensation and could not go about, because, as she said, she felt as if everything was coming into the world. She had to support herself with her hand. I had some moonshine made by Johnstone and I gave that women a dose of that moonshine, and in six or seven days that woman was well. The doctor who uses mechanical supports deprives himself of valuable information in finding the similimum.
Dr. Thomson: There is only one organ in the human body as mobile as the uterus. Its (i, e, the uterus) mobility is essential to its physiological action; without that mobility it can not perform its use, and I do not think we should ever interfere with it by propping it in a fixed position. These cases are curable without such interference.
Two years ago I treated a young lady about twenty years old, who had been suffering a long time with severe pelvic pains. She had been sick five or six years, the trouble dating from her first menstrual flow, which had been stopped by bathing at the time of its first appearance. All the indications pointed to Dulcamara; I gave her a dose and recommended the prone position. In the course of six moths she took three doses of Dulcamara.
She improved steadily until she developed an irritability that made it almost impossible to live in the same house with her. This was cured by Chamomilla, and there has been no trouble since. Nothing was done for her except the administration of these two remedies and the position recommended. I have never found it necessary to use mechanical support, even in the case of washerwomen with procidentia, who had to be about their daily tasks.
Dr. Hawley: Dr. Stow’s case reminds me of what Dr. Lippe said in a similar case of retroflexion of the uterus with waste of tissue. Unquestionably, he said, this waste of tissue is dynamic in its cause and how can a dynamic condition be removed by mechanical means? it is simply absurd to think so.
Dr. H.C. Allen: I think Dr. Stow gave himself away pretty badly when he said he did not know whether the support or the Sepia did the work. Dr. Stow can not tell to-day what part the Sepia took and what art the support took in the cure. There is no means of knowing and such clinical knowledge is worthless.
Dr. Stow: One or two words in self-defense. I wish to ask this intelligent audience, if I had treated that case with the remedy alone, and allowed the woman to keep about her work without any support, could I have hoped to effect a cure? (Cries of “yes,” “certainly,” from different parts of the room.) I certainly think not.
Dr. Kent: I should like to stand here about two hours and a half, and report just such cases as Dr. Stow reported, cured by the internal remedy alone. i used to examine my cases very frequently so that my information as to the position or malposition of the uterus of my patients used to be more extensive than it is nowadays. I simply used to keep myself posted as a matter of clinical information.
I consider Dr. Stow’s treatment just the same as if he had used two remedies. He does not know whether he has cured his patient or merely palliated the trouble. Many of these cases may be made comfortable for a time by local treatment, it may take St. Paul himself to cure the case. it is not real homoeopathic treatment, though it might be in New York.
Dr. Custis: I do not think it wise to stop examining our cases, if only for the satisfaction it affords of giving a correct diagnosis and an intelligent prognosis to our patients, both for their protection and our protection; moreover, we can not be sure of what we have cured unless we have made an examination on first taking the case, and the certain knowledge so gained gives stronger and better arguments to back up such a paper as we have heard here to-day.
It is not fair to say we have cured a mal-position, because we have removed the symptoms of mal-position, unless we have first made an examination and actually found out that there was mal-position present.
Then we can down allopathic objectors instead of being downed by them. A good diagnosis is a great protection and a strong argument.
Dr. Wesselhoeft: I agree with dr. Custis on that point. I think it is very important one. I know that many of the co-called flexions and mal-positions of the uterus remain and the patient gets well, and on the other hand, i know from experience that patients will come to you saying: “Doctor, I have been treated for two years by Dr. B. for retroversion. He says I am perfectly well now in that respect, but he wants me to go to my family physician and get the constitutional symptoms cured”.
Dr. Alice B. Campbell: I do not agree with Dr. Custis. being a woman I have naturally greater freedom in these cases than a man, and because I am a woman, I do not take advantage of that freedom. You can have just as much distress without the uterus being displaced at all as you can with an apparently serious displacement. If you can displace the distress, it makes no difference where the uterus is. If there is no suffering it is probably all right. I do not see why we have to go over this ground every year, it seems to me we had settled it long ago on a harmonious basis.
Dr. Wm. Jefferson Guernsey: I think with Dr. Campbell that we waste a great deal of time in going over the same ground every year, and would suggest that a repetition of this discussion could be avoided by the purchase of a phonograph.
Dr. Butler: Is it not our duty to examine our patients as thoroughly and completely as possible. Does not Dr. Campbell make the best examination of the kidney that their situation and accessibility will allow? Should not every organ be examined as far as it can be?.
Dr. Stow: It seems to me that is a very nice point. Before you can make out an accurate diagnosis of an affection of the kidneys, you are obliged to make chemical examinations of the urine. You do not know what you are treating unless you do; and just so I believe when a patient comes complaining of displacement of the uterus, or of symptoms pointing to it, it is our day, before undertaking to cure the case, to find out whether it be true or not.
Dr. Brownell; I should like to ask if the influence of the clothing is not very important in the treatment of displacements? I believe that very often such cases are incurable unless the constant displacing effect of the clothing is removed.
Dr. Hawley: This last is a very good point. I can remember when these weaknesses were known. My mother had nothing of the kind. She wore her bells just below the breasts with a long skirt, all supported by the shoulders, and I believe that was the reason she did not have any of these troubles. It is impossible to be healthy and be dressed the way most women are nowadays, some organs crowded up and some crowded down. Continued strain on a muscle will invariably cause it to relax, and this continued downward pressure causes the floor of the pelvis to finally give way and the organs are left to drop down for lack of normal support.
Dr. Johnstone: I am much indebted to a Mclntosh supporter for a fairly round fee. About six months ago a woman, forty-three years old, came to me with bearing down pains in the pelvis, and a great many other symptoms. I found she had been wearing a Mclntosh supporter to hold her in position for the last three or four years. I simply removed it and gave her a package of placebo powders to wait for her to develop symptoms. In two weeks she was well and found to her surprise that she was better without her supporter than with it.
Dr. Stow: I believe there is such a thing as going too far in this of non-interference. There is no man or woman in this audience who is more radical or a greater stickler for right than I am. I will take second pace to nobody on that score. It seems to be the direct outcome of this discussion to discard anything and everything of a surgical nature. It throws out all mechanical interference with cases.
Mechanical means, appliances and aids have a field and are perfectly legitimate in the practice of medicine. it may be that Sepia alone would have cured my case, but I am inclined to think not. But costing aside that, we have another fact, that without any homoeopathic medication, without any mechanical support, pregnancy would have solved and cured that case, if pregnancy were than possible.
I am certain that the patient was vastly benefited, whether you attribute it to the Sepia, to the support, or to the pregnancy, and finally, you must either exclude the whole subject of surgery from the discussions of this society, or you must administer technique.
Dr. Custis: I do not want to be understood as examining every lady that comes to my office, but when we get no results from our treatment, I think we should make an examination to find out the trouble. We should feel very badly if after we had failed to make an examination to find out the trouble. We should feel very badly if after we had failed to make an examination and also failed to cure a case, some other doctor found a fibroid, which we knew nothing about. It could not fail to be a reflection on us.